contraceptives--postcoital and Neoplasms

To highlight the characteristics of progestin-only contraceptives (POCs) currently available in the United States, and to explore the potential of these agents as first-line contraceptive options for women seeking health promotion by prevention of an unwanted pregnancy. The progestin-only pills (Micronor and Ovrette), depot medroxyprogesterone acetate (DMPA) injections (Depo-Provera and depo-subQ provera 104), levonorgestrel intrauterine system (IUS) (Mirena), and etonogestrel implant (Implanon) will be reviewed. The use of levonorgestrel (Plan B) as an emergency contraceptive will also be considered briefly.. Worldwide medical literature and the prescribing information for the specified products.. A number of POCs are currently available for routine birth control in the United States, ranging from the daily progestin-only pill to nondaily contraceptive options such as injectable DMPA, the levonorgestrel-releasing IUS, and the etonogestrel-releasing contraceptive implant. Each of these methods has specific advantages, but also specific drawbacks that can result in discontinuation of treatment if users are not given adequate information about what to expect in terms of side effects. It is critical that clinicians provide adequate and accurate information along with detailed counseling to women who are considering using POCs, as well as providing periodic reinforcement of the information at regular clinic visits for those already using POCs.. Given that a large number of pregnancies are unplanned and create a significant impact on social, economic, and health outcomes, it is important for the clinician to have a vast knowledge of contraceptive options. POCs offer significant choices in contraception. By proactively addressing common concerns (such as potential effects on weight, mood, menstrual bleeding patterns, and bone mineral density), clinicians may improve the likelihood of adherence and continuation with POCs for routine birth control.

Topics: Contraceptive Agents, Female; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Counseling; Desogestrel; Drug Prescriptions; Family Planning Services; Female; Health Promotion; Humans; Levonorgestrel; Medroxyprogesterone Acetate; Neoplasms; Norethindrone; Norgestrel; Patient Education as Topic; Patient Selection; Pregnancy, Unplanned; Progesterone Congeners; Risk Factors; United States

Topics: Abortion, Induced; Animals; Cervix Uteri; Clinical Trials as Topic; Contraceptives, Postcoital; Endometriosis; Female; Humans; Hydrocortisone; Labor, Induced; Mifepristone; Misoprostol; Neoplasms; Pregnancy

Topics: Amenorrhea; Biological Assay; Carbohydrate Metabolism; Contraceptive Agents; Contraceptives, Oral; Contraceptives, Postcoital; Estrogens; Eye Diseases; Female; Gonadotropins; Humans; Hypertension; Lipoproteins; Liver; Nandrolone; Neoplasms; Ovulation; Progesterone; Skin Manifestations; Testosterone; Thromboembolism; Transcortin

Science and modern medicine accord us many advantages, e.g., contraceptive drugs, but many people still do not use them. Contraceptive drugs include oral contraceptives and injectables. OCs are very effective and are associated with minor side effects (e.g., mood changes, breast tenderness, nausea, and changes in weight, mild headache, and spotting between periods), perhaps explaining why they are one of the most often used contraceptive in essentially every country. Women who smoke; are 35 years old; or either have or have a family history of hypertension, diabetes, cardiovascular disease and use OCs are at higher risk of a cardiovascular episode. On the other hand, OCs protect against ovarian and endometrial cancers. Research does not yet confirm or disprove their effect on breast cancer development. OCs appear not to be linked to breast cancer through age 59. Yet, studies of women 45 years old suggest that OCs increases the breast cancer risk in these women who had their first menses before age 13 and used OCs for a long time before their first pregnancy. OCs may facilitate growth of breast tumors that other causes activated, and therefore, do not likely increase the overall risk. Researchers recognize the death of knowledge about breast cancer development, so they call for more research, including basic molecular, cellular, and biochemical studies. In Nigeria, breast cancer is rare, while deaths due to pregnancy and childbirth are common, indicating that OC use can prevent many female deaths. Prolonged breast feeding; later age at first menses; earlier age at menopause; earlier age at first full-term pregnancy larger families; low fat, high fiber diets; and thinness, all of which are common in developing countries, have a protective effect against breast cancer. Further, women in developing countries begin OC use later than women in developed countries.

Topics: Africa; Africa South of the Sahara; Africa, Western; Ambulatory Care Facilities; Biology; Birth Rate; Breast Neoplasms; Communication; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Counseling; Demography; Developing Countries; Disease; Endometrial Neoplasms; Evaluation Studies as Topic; Family Planning Services; Fertility; Health Planning; Injections; Neoplasms; Nigeria; Organization and Administration; Ovarian Neoplasms; Parity; Population; Population Dynamics; Progesterone Congeners; Research; Risk Factors

RU-486's primary use as an abortifacient stirs controversy in the US. Changes in US policy have opened the door for RU-486 to be made available for research. The Population Council plans on conducting a multicenter clinical trial of RU-486 involving at least 2000 women. This is the first step to obtaining possible approval from the Food and Drug Administration. RU-486 alone has an effectiveness rate of inducing abortion between 80 and 90%. When taken 36 to 48 hours before a prostaglandin (PG) analogue, the rate climbs to about 95%. Possible side effects of RU-486 and the analogue are bleeding, abdominal pain, and cardiovascular problems (rare). More than 100,000 women in France have undergone the RU-486/PG analogue regimen. RU-486 also has contraceptive qualities. If taken every day during the week before ovulation, it prevents ovulation. 12 days of RU-486 administration followed by 10 days of administration of a synthetic progestin also suppresses ovulation. Taking RU-486 during the last 10 to 12 days of the menstrual cycle alters the endometrium, thereby preventing implantation. A single dose of RU-486 during the late luteal phase is about 80% effective at bringing on menses. The aforementioned effects of Ru-486 demonstrate that it may be an effective postcoital contraceptive. Besides, RU-486 has fewer side effects than other postcoital contraceptive regimens. Further, RU-486 softens and dilates the cervix, thus it can be used to induce labor and ease delivery. Evidence suggests that RU-486 may be used to treat hormone-dependent breast tumors, Cushing's syndrome, meningiomas, and endometriosis.

Topics: Abortifacient Agents; Abortion, Induced; Americas; Biology; Breast Neoplasms; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Postcoital; Developed Countries; Disease; Embryo Implantation; Endocrine System; Endometrium; Europe; Family Planning Services; France; Genitalia; Genitalia, Female; Hormone Antagonists; Hormones; Labor Stage, First; Menstruation; Mifepristone; Neoplasms; North America; Ovulation; Physiology; Therapeutics; United States; Urogenital System; Uterus

This work describes oral contraceptives (OCs) in current use and examines their risks. OC pills are composed of synthetic estrogens, usually either ethinyl estradiol or mestranol, and progestins. Either estrogens or progestins can be used alone, but combinations permit smaller doses to be used. Combined pills are available in monophasic, biphasic, or triphasic formulations. Different modalities of administration are also available for progestin-only pills. The "morning after" pill containing high doses of steroids to be taken within 72 hours of unprotected intercourse can contain either estrogen or progestin alone or combined. The mechanisms of action of OCs vary according to the type of pill. Classic combined OCs inhibit ovulation, render the cervical mucus inhospitable to sperm, and cause endometrial atrophy which hinders nidation. Low-dose pills have various effects but in general depend on changes in the cervical mucus for their contraceptive effect. Pregnancy may result from forgetting pills or using them incorrectly, or in the case of low-dose pills may occur even if they are used correctly. Some drugs can lower the concentrations of the OC hormones at the level of the receptors by hindering their intestinal absorption or by increasing the metabolic power of the liver. Considerable individual variability limits the incidence of pill failure due to drug interactions, but OC use should be avoided if rifampicine or certain other drugs are used. Among undesirable effects of OCs on endocrine glands and reproductive function are the adaptation syndrome characterized by symptoms similar to those of early pregnancy and reversible in most but not all women; galactorrhea resulting from diminished levels of "prolactin inhibiting factor"; and virilizing effects such as alopecia, hirsutism, and acne usually occurring during use of high-dose formulations. Pills should be carefully adapted to the hormonal profile of the user to avoid these side effects. OCs very rarely entail longterm infertility. OCs in current use do not appear to be teratogenic but it is advisable to wait 2 months after termination of use before becoming pregnant. Lactation is a contraindication to OC use. Combined OCs frequently cause problems in glucose tolerance of variable significance. Low-dose progestins do not seem to affect lipid metabolism, but low and normal dose combined pills may provoke increases in the levels of cholesterol and triglycerides. OCs are implicated

Topics: Biology; Cardiovascular System; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Disease; Endocrine Glands; Endocrine System; Family Planning Services; Hormones; Lipids; Liver; Metabolism; Neoplasms; Physiology; Research

Various postcoital contraceptive regimens are described. An antiemetic can be given to minimize the nausea and vomiting which are side effects of high-dosage estrogen. If pregnancy occurs despite treatment, the possible risk to the fetus is unknown. This method of contraception is only for emergency use. Regular contraception should be employed if sexual exposure is to be continuing.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Diethylstilbestrol; Disease; Embryo, Mammalian; Embryo, Nonmammalian; Endocrine System; Estrogens; Estrogens, Conjugated (USP); Estrone; Ethinyl Estradiol; Family Planning Services; Fetus; Hormones; Nausea; Neoplasms; Physiology; Pregnancy; Reproduction; Signs and Symptoms; Vomiting

Topics: Abortion Applicants; Abortion, Induced; Abortion, Legal; Abortion, Therapeutic; Adolescent; Adult; Congenital Abnormalities; Contraceptives, Postcoital; Female; Fetal Diseases; Heart Diseases; Humans; Hypertension; Kidney Diseases; Mental Disorders; Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, First; Pregnancy Trimester, Second; Radiation Injuries; Socioeconomic Factors

Topics: Blood Pressure; Carbohydrate Metabolism; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Diethylstilbestrol; Female; Humans; Intrauterine Devices; Lipid Metabolism; Male; Medroxyprogesterone; Neoplasms; Pregnancy; Prostaglandins; Thromboembolism

This is a general review of the types of steroid contraceptives, their mode of action and efficacy, and major complications, including thromboembolism, cancer, jaundice, diabetes and hypertension. Tables show combined and sequential pills available in Belgium, by brand name, manufacturer, and composition. About 300,000 Belgian women use the pill. Since endometrial cancer is probably, and cervical cancer certainly, not enhanced by the pill, the maternal death rate among pill users is about 5% of the rate among unprotected sexually active women.

Topics: Chemical and Drug Induced Liver Injury; Contraceptives, Oral; Contraceptives, Postcoital; Estrogens; Hypertension; Injections; Neoplasms; Progestins; Thromboembolism; Time Factors

The use of diethylstilbestrol (DES) as a postcoital contraceptive agent is discussed. DES is associated with nausea, an increased risk of thrombosis, and is suspect in endometrial and breast cancer, and vaginal cancer in the progeny of mothers treated during pregnancy. Postcoital estrogens do not seem to be as effective as conventional oral contraceptives. Although DES is most likely not an abortifacient agent, its mode of action is not certain. Nonetheless, the relatively high number of ectopic pregnancies among method-failures suggests that DES delays ovum transport. It is concluded that routine postcoital use of DES is too hazardous, and that abortion is strongly indicated if the method fails.

Topics: Contraceptives, Postcoital; Diethylstilbestrol; Female; Humans; Neoplasms; Pregnancy; Pregnancy, Ectopic; Self Medication

Topics: Adenocarcinoma; Contraceptives, Oral; Contraceptives, Postcoital; Diethylstilbestrol; Female; Fetus; Humans; Neoplasms; Pregnancy; Time Factors; Vaginal Neoplasms

122 patients with histologically confirmed squamous cell carcinoma of the cervix admitted to the gynecological wards of Charity Hospital in New Orleans from July 1, 1959, through March 31, 1960, were studied; suitable controls were selected from the same wards. All interviews were conducted by the same interviewer nurse who was unaware of the diagnoses. Hospital charts were later examined. Educational level of patients, occupation of husband and father, residence, original diagnosis, and religion were similar to those of controls. Less than 1/3 had more than grammar school education. Most husbands and fathers were farmers of unskilled laborers. In only 1/5 of the patients had the original cancer diagnosis been made by private physicians or at noncharity hospitals. About 45% were Catholics, 45% Baptists, and the remaining 10% other Protestant denominations. 49% of the patients and 43% of the controls reported 6 or more pregnancies. Douching practices were similar to controls; few had ever used other contraceptive measures. 13 patients and 6 controls had positive serological tests for syphilis. Only 6, 1 patient and 5 controls, had never been married. Of cancer patients, 47% had been married more than once vs. 16% of controls. 34% of the patients with cancer were married before the age of 17 vs. 14% of controls. 54% of patients with cancer and 26% of controls reported extramarital partners. 53% of patients had 1st coitus before age 17 vs. 26% of the controls. There was a considerably higher frequency of coitus in patients than in controls. It is concluded that no relation between number of pregnancies and cancer was shown. Douching with coal tar derivatives was not a factor. The association of carcinoma and syphilis was not certain as many had never had a serological test. The effect of circumcision of partners was not determined as it was often unknown. A significant association was shown with early marriage, extramarital relations, coitus at an early age, and frequent coitus at all ages.

Topics: Age Factors; Behavior; Birth Rate; Coitus; Contraception; Contraception Behavior; Contraceptives, Postcoital; Demography; Disease; Education; Epidemiologic Methods; Family Planning Services; Fertility; Infections; Marital Status; Marriage; Neoplasms; Parity; Population; Population Characteristics; Population Dynamics; Religion; Reproduction; Research; Sexual Behavior; Sexually Transmitted Diseases; Social Class; Uterine Cervical Neoplasms